Provider Demographics
NPI:1760895684
Name:DAYSPRING COMMUNITY SERVICES
Entity Type:Organization
Organization Name:DAYSPRING COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WITMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-712-0859
Mailing Address - Street 1:400 E CENTRAL AVE
Mailing Address - Street 2:SUITE 504
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-5429
Mailing Address - Country:US
Mailing Address - Phone:918-712-0859
Mailing Address - Fax:918-388-9708
Practice Address - Street 1:400 E CENTRAL AVE
Practice Address - Street 2:SUITE 504
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-5429
Practice Address - Country:US
Practice Address - Phone:918-712-0859
Practice Address - Fax:918-388-9708
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALTERNATIVE OPPORTUNITIES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100746170Medicaid